What is YOUR ED "out" of ?

[RustedFox]

Things my ED is currently "out of" (no joke)...

Zofran
Phenergan
Compazine
Toradol
Etomidate


... feel free to add/complain/suggest alternative meds/alternative jobs/alternative beers...

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[The White Coat Investor]

Zofran, phenergan, compazine, reglan, toradol, dilaudid, etomidate and ear speculums in every other room. We've got inapsine though. And po toradol.

 

[Foster23]

Ativan

 

[southerndoc]

We're actually getting low on lidocaine.

 

[EM4life]

zofran, ativan, versed, compazine, etomidate ::sigh::

 

[deleted65604]

morphine, zofran, versed, IV levaquin

 

[deleted109597]

Morphine, zofran, and nurses who know how to start IVs.

 

[EM2BE]

Morphine, zofran, and nurses who know how to start IVs.

Reminds me. This past week I had to place 2 IVs. This is the first time in 1.5 years. Other times they couldn't get IVs, the pt needed a central line.

At another location, it's more common they can't get lines (more IVDA), but they have a resident who does pretty much all the procedures while they are there, so I never had to do one there.

 

[pinipig523]

IV diazepam

 

[subtle1epiphany]

Zofran, phenergan, compazine, reglan, toradol, dilaudid, etomidate and ear speculums in every other room. We've got inapsine though. And po toradol.

Curious, what have you been doing for those patients with nausea/emesis? Droperidol, Benadryl, scopolamine? Just saw that Inapsine is droperidol...guess that explains it...
annoying as hell, decreased patient care at times in situations, but also we do learn to become more adaptive and use older less used agents, that isn't always a bad thing...

 

[bulgethetwine]

Hot nursing staff.

 

[EM4life]

I'm curious what others preferences are regarding patients requiring urgent access but still semi conscious would you first reach for the central line or IO access?

 

[bulgethetwine]

I'm curious what others preferences are regarding patients requiring urgent access but still semi conscious would you first reach for the central line or IO access?

Hi Jack - Nice to meet you.

 

[SoCuteMD]

Morphine, Reglan, Valium, Etomidate.

 

[RustedFox]

Hi Jack - Nice to meet you.

How many kids with ADHD does it take to change a lightbulb ?

.... Wanna ride bikes ?

 

[xaelia]

We're all out of inpatient beds.

Had 18 patients yesterday at one point - only three of which did not have a request for admission entered.

I love playing amateur IM doc.

 

[EM4life]

LOL sorry I realize my question doesn't seem related - I guess I thought of it when the comment about nurses who cannot start lines showed up...

 

[Greenbbs]

Paying patients and minor complaints.

 

[Greenbbs]

We're all out of inpatient beds.

Had 18 patients yesterday at one point - only three of which did not have a request for admission entered.

I love playing amateur IM doc.

We have a hospitalist team in our ED 24/7. Makes life grand

 

[GeneralVeers]

We were out of dilaudid one day a few months ago. That was the best day ever. I could legitimately tell all the druggies with morphine "allergies" that there was nothing I could give them.

 

[SoCuteMD]

We were out of dilaudid one day a few months ago. That was the best day ever. I could legitimately tell all the druggies with morphine "allergies" that there was nothing I could give them.

They didn't ask for "that F stuff"?

 

[southerndoc]

Curious, what have you been doing for those patients with nausea/emesis? Droperidol, Benadryl, scopolamine? Just saw that Inapsine is droperidol...guess that explains it...
annoying as hell, decreased patient care at times in situations, but also we do learn to become more adaptive and use older less used agents, that isn't always a bad thing...

Zofran ODT's work well.

 

[southerndoc]

I hate that we're low on Toradol. One of our hospitals is completely out. I'm hoping the drug seekers don't get word of it!

 

[TheBlueBlazer]

Not completely out but dangerously low on zofran, toradol, etomidate, dilaudid, propofol, IV levaquin, and all IV benzos. We're using a ton of midazolam syrup and zofran ODTs, so they'll probably be gone soon

 

[SoCuteMD]

Zofran ODT's work well.

Not if you don't have them!

 

[southerndoc]

Not if you don't have them!

Give 'em a placebo.

 

[StevieStud]

complaint forms.

I am always out of complaint forms whenever I am asked for one.

I am also out of blank prescription pads for the "do it yourself at home crowd".

 

[The White Coat Investor]

We're not out of Ofirmev. I gave 5 doses today.

 

[Arcan57]

Used our hospital's last dose of compazine on a migrainer that says she usually gets something that starts with "dilau" for her pain. Have been out of IV reglan for months, we were out of IV zofran (which is given with every dose of IV pain meds in the ED) but have been building back up a supply.

 

[EM2BE]

We were just informed we have toradol again. Still low on zofran. I think we are completely out of IV valium. I have been giving a lot of PO ativan as we are really low on IV. Saving IV/IM form for psych issues. We do have reglan.

It's hard for me to know what we are out of because I'm only in the dept at my base hospital for a short time this year (<half the year). It varies from location to location though. I usually find out soon after I order something that we are out of it or that the pharmacy is rationing it so they have to go to the pharmacy to get it. Actually haven't had a migraine patient since I've been back in the dept this month. Maybe the patients are learning we are all limited and to just stay home. I also have a set of attendings who are great and will not give out narcs like candy. Maybe that has helped as well.

 

[deleted109597]

We're not out of Ofirmev. I gave 5 doses today.

Moneybags.

 

[njac]

We're not out of Ofirmev. I gave 5 doses today.

why?

(legitimately curious - the best argument I've heard for the stuff is a febrile neutropenic patient with mucositis that you don't want to give PR APAP to - otherwise?)

 

[RustedFox]

Okay, forgive me for being willfully ignorant - but just why the hell are we out of all these commonly consumed meds in the first place ? You'd think that with the way we use them (zofran w/ every dose of narcs, etc) that the supply would meet the demand.

Make some freakin' drugs, pharma-misers.

 

[docB]

I guess I missed this topic when it first came up. In Vegas we are having a lot of really serious shortage issues. Some specifics just FYI:

We're actually getting low on lidocaine.

So are we. We are completely out of morphine, etomidate, IV magnesium, IV Zofran, IV Compazine, IV Phenergan, IV Reglan, Vecuronium and the reagent to do serum acetone testing. We're also out of some other stuff I can't recall right now.

I'm curious what others preferences are regarding patients requiring urgent access but still semi conscious would you first reach for the central line or IO access?

LOL sorry I realize my question doesn't seem related - I guess I thought of it when the comment about nurses who cannot start lines showed up...

Would you like me to move this question to a new thread?

We were out of dilaudid one day a few months ago. That was the best day ever. I could legitimately tell all the druggies with morphine "allergies" that there was nothing I could give them.

Everyone in town was out that day. It was glorious. I had a chronic pelvic pain girl who was writhing in "pain" and when I told her we were out of Dilaudid and Morphine she sat up and in a perfectly normal voice said "Really?" and then just got up and walked out without even a whimper.

They didn't ask for "that F stuff"?

No one in Vegas knows about the "F" yet. I hope it stays that way.

Zofran ODT's work well.

We just had an emergency meeting to approve Zofran ODT for our EMS system. It kind of highlighted a difference between hospitals and EMS. In a hospital you just tell all the docs and switch. In EMS you have to change the protocols which is time consuming.

Give 'em a placebo.

I know you were kidding but we actually have a policy that prohibits us from using placebos. Even if you don't have that nursing standards require nurses to tell the patient what a drug is and what it's for. So theoretically they could give a placebo but would have to tell them that's what it is.

Okay, forgive me for being willfully ignorant - but just why the hell are we out of all these commonly consumed meds in the first place ? You'd think that with the way we use them (zofran w/ every dose of narcs, etc) that the supply would meet the demand.

Make some freakin' drugs, pharma-misers.

The drug shortage problem is due to the fact that all of these drugs are old (i.e. off label), cheap, and being IV are only sold to hospital and EMS providers who have the ability to buy in bulk and demand low prices. So the profit margin on these drugs is very low. When the factory breaks the drug company puts fixing it low on the priority list.

 

[jendc08]

Iv zofran, compazine, reglan and phenergan...

 

[GeneralVeers]

I'm permanently out of IV push dilaudid for back pain, chronic abd/pelvic pain, or chronic chest pain. Funny how I seem to be out when those patients roll in.

 

[tegs15]

Well get used to it! This is what happens when the free market is screwed with, can't wait until more and more control is given to government entities.

You see the three largest buyers - including Cardinal Health, Amerisource-Bergan and (sorry spaced the third), were tasked by the hospitals of our fine nation to help control pricing. They did this by forcing down the price of pharmaceuticals by the power of a oligopoly. They are the middle men in the purchase of most medical items, but especially drugs. They have been dictating the price to the pharmaceutical companies that hospitals are willing to pay for a few years now. However the manufactures are not willing to make IV injectible meds for so cheap when they can make something else on their production lines that has greater profit. They are also not willing to out the buyers as the cause of the "shortage" and negotiate with the hospitals themselves, as they also buy all their other medication, so what do they do?
They stop manufacturing cheap products, tell the buyers they are not producing those items until the price is increased. The buyers meanwhile tell all the hospitals that there is a nationwide shortage. The public and medicine returns to the medicine of 1970-80s giving Droperidol with an EKG or new, expensive Kytrel for nausea.

(didn't you wonder why this "shortage" really only seems to be injected meds? Clinics and pharmacies still have plenty of ODT, though there is going to be a strain as we change our practice to more oral medications?)

 

[EM2BE]

We are also out of the reagent for acetone testing. The lab did offer to do a send-out b-hydroxybutyrate for us though :/

 

[Apollyon]

So are we. We are completely out of morphine, etomidate, IV magnesium, IV Zofran, IV Compazine, IV Phenergan, IV Reglan, Vecuronium and the reagent to do serum acetone testing. We're also out of some other stuff I can't recall right now.

All of those are optional except the mag - how can you be out of mag? Nobody dies if their Phenergan or Vecuronium level is too low. The risk managers should be exerting their considerable might in the case of the mag.

 

[Sweet Pea]

I don't think the risk managers for the drug companies care. The shortage has hit chemo agents as well.

 

[njac]

(didn't you wonder why this "shortage" really only seems to be injected meds? Clinics and pharmacies still have plenty of ODT, though there is going to be a strain as we change our practice to more oral medications?)

There's been a national shortage of oral ADHD meds for several months now. And several of my friends are out of Zofran ODT at their hospitals.

 

[njac]

All of those are optional except the mag - how can you be out of mag? Nobody dies if their Phenergan or Vecuronium level is too low. The risk managers should be exerting their considerable might in the case of the mag.

Wasn't it last year (July 2010 or so as I had just moved to Chicago) that there were shortages of most of the crash cart meds? I distinctly remember being out of D50 and bicarb and carrying a vial of the 1mg/mL epi in my pocket to make up 1mg doses at every code.

Even the flipping Mayo Clinic is nearly out of Methotrexate right now.

 

[Apollyon]

Wasn't it last year (July 2010 or so as I had just moved to Chicago) that there were shortages of most of the crash cart meds? I distinctly remember being out of D50 and bicarb and carrying a vial of the 1mg/mL epi in my pocket to make up 1mg doses at every code.

Even the flipping Mayo Clinic is nearly out of Methotrexate right now.

Epi was the only thing of which we were short. We were good with the D50, atropine, and bicarb.

 

[docB]

All of those are optional except the mag - how can you be out of mag? Nobody dies if their Phenergan or Vecuronium level is too low. The risk managers should be exerting their considerable might in the case of the mag.

EMS here hasn't had it for a while. I think the pharmacy is restricting it to eclamptics and true hypomagnesemics. No more mag in every banana bag.

 

[Cerberus]

Zofran IV, Ativan IV are the two biggies that come to mind. Also running low on Versed (due to the shortage of ativan). I had to review equivalencies of iv benzos yesterday when my inpatient ETOH withdrawal stopped taking PO ativan and got all "those bees are ****ing EVERYWHERE".

 

[dchristismi]

We're out of IV compazine, IV reglan, IV zofran, IV Valium and I hear that the acetone thing is a nationwide problem. Thankfully still have Zofran ODT, and pharmacy gave in and is now doing phenergan 12.5 in IVpiggybacks. (It used to be our antiemetic/antimigraine of last resort and we had to document why we needed it. No longer.)

Running low on IV Levaquin, and etomidate is only in the RSI kits for now. At least we have plenty of propofol. (Unlike a few months ago, when we ran out of that too)

At one point we didn't have IV benadryl - or at least were reserving it for true emergencies.

 

[The White Coat Investor]

Told two headache patients we were short on dilaudid today. Am I bad? (We were short not too long ago.)

 

[deleted65604]

In addition to what I mentioned before, we are also out of the reagant to test for acetone. It is now a send-out test... as if that is helpful clinically.

 

[Arcan57]

Told two headache patients we were short on dilaudid today. Am I bad? (We were short not too long ago.)

I just tell them I don't treat headaches with dilaudid. Also, when you start listing off drug reactions for every non-opioid treatments (including my favorite: is that similar to Haldol?) when you just answered that you had no known drug allergies then you lose. Game over, thanks for playing.

 

[xaelia]

Etomidate, diazepam, ketamine, metoclopramide, ondansetron, prochlorperazine, promethazine, mannitol, potassium phosphate, lasix, lidocaine, fentanyl, and gentamicin are near zero.

At a trauma level one tertiary academic center.